Combination ultrasonic and electrosurgical instrument and method for sealing tissue with various termination parameters

ABSTRACT

An ultrasonic surgical instrument and method of sealing a tissue includes measuring a first measured termination parameter with a controller and terminating an ultrasonic energy and an RF energy when the first measured termination parameter reaches a set one of a first smaller tissue predetermined termination parameter or a first larger tissue predetermined termination parameter to thereby inhibit transecting the tissue. The ultrasonic surgical instrument further includes an end effector having an ultrasonic blade, an RF electrode, and a controller. The controller operatively connects to the ultrasonic blade and the RF electrode and is configured to terminate the ultrasonic energy and the RF energy when the first measured termination parameter reaches the set one of the first smaller tissue predetermined termination parameter or the first larger tissue predetermined termination parameter to thereby inhibit transecting the tissue.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Pat. App. No.62/509,336, entitled “Control Algorithm for Surgical Instrument withUltrasonic and Electrosurgical Modalities,” filed May 22, 2017, thedisclosure of which is incorporated by reference herein.

BACKGROUND

Ultrasonic surgical instruments utilize ultrasonic energy for bothprecise cutting and controlled coagulation. Ultrasonic energy cuts andcoagulates by vibrating a blade in contact with tissue. Vibrating atfrequencies of approximately 55.5 kilohertz (kHz), for example, theultrasonic blade denatures protein in the tissue to form a stickycoagulum. Pressure exerted on the tissue with the blade surfacecollapses blood vessels and allows the coagulum to form a hemostaticseal. The precision of cutting and coagulation may be controlled by thesurgeon's technique and adjusting the power level, blade edge, tissuetraction, and blade pressure, for example.

Examples of ultrasonic surgical devices include the HARMONIC ACE®Ultrasonic Shears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONICFOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades,all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examplesof such devices and related concepts are disclosed in U.S. Pat. No.5,322,055, entitled “Clamp Coagulator/Cutting System for UltrasonicSurgical Instruments,” issued Jun. 21, 1994, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 5,873,873, entitled“Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,”issued Feb. 23, 1999, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” issued Nov.9, 1999, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,283,981, entitled “Method of Balancing AsymmetricUltrasonic Surgical Blades,” issued Sep. 4, 2001, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,309,400,entitled “Curved Ultrasonic Blade having a Trapezoidal Cross Section,”issued Oct. 30, 2001, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 6,325,811, entitled “Blades withFunctional Balance Asymmetries for use with Ultrasonic SurgicalInstruments,” issued Dec. 4, 2001, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,423,082, entitled“Ultrasonic Surgical Blade with Improved Cutting and CoagulationFeatures,” issued Jul. 23, 2002, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 6,773,444, entitled “Blades withFunctional Balance Asymmetries for Use with Ultrasonic SurgicalInstruments,” issued Aug. 10, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,783,524, entitled“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument,” issued Aug. 31, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,057,498, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 15, 2011, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,461,744, entitled “Rotating Transducer Mount for Ultrasonic SurgicalInstruments,” issued Jun. 11, 2013, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,591,536, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 26, 2013, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,623,027, entitled “Ergonomic Surgical Instruments,” issued Jan. 7,2014, the disclosure of which is incorporated by reference herein; andU.S. Pub. No. 2016/0022305, entitled “Ultrasonic Blade Overmold,”published Jan. 28, 2016, issued as U.S. Pat. No. 9,750,521 on Sep. 5,2017, the disclosure of which is incorporated by reference herein.

Electrosurgical instruments utilize electrical energy for sealingtissue, and generally include a distally mounted end effector that canbe configured for bipolar or monopolar operation. During bipolaroperation, electrical current is provided through the tissue by activeand return electrodes of the end effector. During monopolar operation,current is provided through the tissue by an active electrode of the endeffector and a return electrode (e.g., a grounding pad) separatelylocated on a patient's body. Heat generated by the current flowingthrough the tissue may form hemostatic seals within the tissue and/orbetween tissues, and thus may be particularly useful for sealing bloodvessels, for example. The end effector of an electrosurgical device mayalso include a cutting member that is movable relative to the tissue andthe electrodes to transect the tissue.

Electrical energy applied by an electrosurgical device can betransmitted to the instrument by a generator coupled with theinstrument. The electrical energy may be in the form of radio frequency(“RF”) energy, which is a form of electrical energy generally in thefrequency range of approximately 300 kilohertz (kHz) to 1 megahertz(MHz). In use, an electrosurgical device can transmit such energythrough tissue, which causes ionic agitation, or friction, in effectresistive heating, thereby increasing the temperature of the tissue.Because a sharp boundary is created between the affected tissue and thesurrounding tissue, surgeons can operate with a high level of precisionand control, without sacrificing un-targeted adjacent tissue. The lowoperating temperatures of RF energy may be useful for removing,shrinking, or sculpting soft tissue while simultaneously sealing bloodvessels. RF energy works particularly well on connective tissue, whichis primarily comprised of collagen and shrinks when contacted by heat.

An example of an RF electrosurgical device is the ENSEAL® Tissue SealingDevice by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio. Furtherexamples of electrosurgical devices and related concepts are disclosedin U.S. Pat. No. 6,500,176 entitled “Electrosurgical Systems andTechniques for Sealing Tissue,” issued Dec. 31, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,112,201entitled “Electrosurgical Instrument and Method of Use,” issued Sep. 26,2006, the disclosure of which is incorporated by reference herein; U.S.Pat. No. 7,125,409, entitled “Electrosurgical Working End for ControlledEnergy Delivery,” issued Oct. 24, 2006, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 7,169,146 entitled“Electrosurgical Probe and Method of Use,” issued Jan. 30, 2007, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,186,253, entitled “Electrosurgical Jaw Structure for Controlled EnergyDelivery,” issued Mar. 6, 2007, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,189,233, entitled “ElectrosurgicalInstrument,” issued Mar. 13, 2007, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 7,220,951, entitled“Surgical Sealing Surfaces and Methods of Use,” issued May 22, 2007, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,309,849, entitled “Polymer Compositions Exhibiting a PTC Property andMethods of Fabrication,” issued Dec. 18, 2007, the disclosure of whichis incorporated by reference herein; U.S. Pat. No. 7,311,709, entitled“Electrosurgical Instrument and Method of Use,” issued Dec. 25, 2007,the disclosure of which is incorporated by reference herein; U.S. Pat.No. 7,354,440, entitled “Electrosurgical Instrument and Method of Use,”issued Apr. 8, 2008, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,381,209, entitled “ElectrosurgicalInstrument,” issued Jun. 3, 2008, the disclosure of which isincorporated by reference herein.

Additional examples of electrosurgical devices and related concepts aredisclosed in U.S. Pat. No. 8,939,974, entitled “Surgical InstrumentComprising First and Second Drive Systems Actuatable by a Common TriggerMechanism,” issued Jan. 27, 2015, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 9,161,803, entitled“Motor Driven Electrosurgical Device with Mechanical and ElectricalFeedback,” issued Oct. 20, 2015, the disclosure of which is incorporatedby reference herein; U.S. Pub. No. 2012/0078243, entitled “ControlFeatures for Articulating Surgical Device,” published Mar. 29, 2012,issued as U.S. Pat. No. 9,877,720 on Jan. 30, 2018, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 9,402,682,entitled “Articulation Joint Features for Articulating Surgical Device,”issued Aug. 2, 2016, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 9,089,327, entitled “Surgical Instrumentwith Multi-Phase Trigger Bias,” issued Jul. 28, 2015, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 9,545,253,entitled “Surgical Instrument with Contained Dual Helix ActuatorAssembly,” issued Jan. 17, 2017, the disclosure of which is incorporatedby reference herein; and U.S. Pat. No. 9,572,622, entitled “BipolarElectrosurgical Features for Targeted Hemostasis,” issued Feb. 21, 2017,the disclosure of which is incorporated by reference herein.

Some instruments may provide ultrasonic and RF energy treatmentcapabilities through a single surgical device. Examples of such devicesand related methods and concepts are disclosed in U.S. Pat. No.8,663,220, entitled “Ultrasonic Surgical Instruments,” issued Mar. 4,2014, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2015/0141981, entitled “Ultrasonic Surgical Instrument withElectrosurgical Feature,” published May 21, 2015, issued as U.S. Pat.No. 9,949,785 on Apr. 24, 2018, the disclosure of which is incorporatedby reference herein; and U.S. Pub. No. 2017/0000541, entitled “SurgicalInstrument with User Adaptable Techniques,” published Jan. 5, 2017,issued as U.S. Pat. No. 11,141,213 on Oct. 12, 2021, the disclosure ofwhich is incorporated by reference herein.

While various types of ultrasonic surgical instruments andelectrosurgical instruments, including combinationultrasonic-electrosurgical devices, have been made and used, it isbelieved that no one prior to the inventor(s) has made or used theinvention described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a schematic view of an exemplary ultrasonic surgicalinstrument including a shaft assembly and a handle assembly operativelyconnected to an ultrasonic generator;

FIG. 2A depicts a side view of an end effector of the ultrasonicsurgical instrument of FIG. 1 showing the end effector in an openconfiguration for receiving tissue of a patient;

FIG. 2B depicts the side view of the end effector of FIG. 2A, but withthe end effector in a closed configuration for clamping the tissue ofthe patient;

FIG. 3 depicts a high-level method of interrogating tissue anddetermining tissue seal based on termination parameters for tissue ofvarious size; and

FIG. 4 depicts a version of the method of interrogating tissue anddetermining tissue seal based on termination parameters of FIG. 3.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. EXEMPLARY SURGICAL SYSTEM

FIG. 1 illustrates one example of a surgical system (10) including asurgical instrument (12) and a generator (14) coupled via a cable (16).Surgical instrument (12) has a proximally positioned handle assembly(18), which may also be referred to as a handpiece, a distallypositioned end effector (20), a shaft assembly (22) extendingtherebetween, and an ultrasonic transducer (24). End effector (20)generally includes a clamp arm (26) pivotally connected relative to anultrasonic blade (28) and configured to pivot from an open position ofan open configuration to a closed position of a closed configuration asdiscussed below in greater detail. Ultrasonic blade (28) is acousticallycoupled with ultrasonic transducer (24) via an acoustic waveguide (notshown) for providing ultrasonic energy to ultrasonic blade (28). Inaddition, end effector (20) further includes a plurality of RFelectrodes (30) positioned therealong for contacting the tissue ineither the open or closed position as desired by a clinician. Generator(14) operatively connects to ultrasonic blade (28) and RF electrodes(30) to respectively provide ultrasonic energy and RF energy toultrasonic blade (28) and RF electrodes (30) to thereby cut and/or sealthe tissue is use.

In some versions, clamp arm (26) has two or more electrodes (30). Insome such versions, electrodes (30) of clamp arm are capable of applyingbipolar RF energy to tissue. In some such versions, ultrasonic blade(28) remains electrically neutral, such that ultrasonic blade (28) isnot part of the RF circuit. In some other versions, ultrasonic blade(28) forms part of the RF circuit, such that ultrasonic blade (28)cooperates with one or more electrodes (30) of clamp arm (26) to applybipolar RF energy to tissue. By way of example only, some versions ofclamp arm (26) may have just one electrode (30) that serves as an activepole for RF energy; while ultrasonic blade (28) provides a return polefor RF energy. Thus, the term “electrodes (30)” should be read toinclude versions where clamp arm (26) has only one single electrode.

It should be understood that terms such as “proximal” and “distal” areused herein with reference to surgical instrument (12). Thus, endeffector (20) is distal with respect to the more proximal handleassembly (18). It will be further appreciated that for convenience andclarity, spatial terms such as “upper” and “lower” are used herein withrespect to the drawings. However, surgical instruments are used in manyorientations and positions, and these terms are not intended to belimiting and absolute. Likewise, terms such as “instrument” and “device”as well as “limit” and “cap” may be used interchangeably.

A. Exemplary Generator

With reference to FIG. 1, generator (14) drives a combination surgicalinstrument (12) with both ultrasonic and RF energies. Generator (14) isshown separate from surgical instrument (12) in the present example,but, alternatively, generator (14) may be formed integrally withsurgical instrument (12) to form a unitary surgical system. Generator(14) generally includes an input device (32) located on a front panel(34) of generator (14). Input device (32) may have any suitable devicethat generates signals suitable for programming the operation ofgenerator (32). For example, in operation, the clinician may program orotherwise control operation of generator (32) using input device (32)(e.g., by one or more processors contained in the generator) to controlthe operation of generator (14) (e.g., operation of the ultrasonicgenerator drive circuit (not shown) and/or RF generator drive circuit(not shown)).

In various forms, input device (32) includes one or more buttons,switches, thumbwheels, keyboard, keypad, touch screen monitor, pointingdevice, remote connection to a general purpose or dedicated computer. Inother forms, input device (32) may having a suitable user interface,such as one or more user interface screens displayed on a touch screenmonitor. Accordingly, the clinician may selectively set or programvarious operating parameters of the generator, such as, current (I),voltage (V), frequency (f), and/or period (T) of a drive signal orsignals generated by the ultrasonic and RF generator drive circuits (notshown). Specifically, in the present example, generator (32) isconfigured to deliver various power states to the surgical instrument(10) that include, but are not necessarily limited to, only ultrasonicenergy, only RF energy, and a combination of ultrasonic and RF energies,which simultaneously powers ultrasonic blade (28) and RF electrodes(30). It will be appreciated that input device (32) may have anysuitable device that generates signals suitable for programming theoperation of generator (14) and should not be unnecessarily limited toinput device (32) shown and described herein.

By way of example only, generator (14) may comprise a GEN04 or GEN11sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. In addition, orin the alternative, generator (14) may be constructed in accordance withat least some of the teachings of U.S. Pub. No. 2011/0087212, entitled“Surgical Generator for Ultrasonic and Electrosurgical Devices,”published Apr. 14, 2011, issued as U.S. Pat. No. 8,986,302 on Mar. 24,2015, the disclosure of which is incorporated by reference herein.

B. Exemplary Surgical Instrument

Surgical instrument (10) of the present example shown in FIG. 1 includesa plurality of energy inputs, which are more particularly referred toherein as an upper button (36), lower button (38), and side button (40).By way of example, upper button (36) is configured to direct generator(14) to power ultrasonic transducer (24) with a maximum ultrasonicenergy output, whereas lower button (38) is configured to directgenerator (14) to power ultrasonic transducer (24) with a lowerultrasonic energy output. By way of further example, side button (40) isconfigured to direct generator (14) to power ultrasonic transducer (24)with a pulsed energy output, such as 5 continuous signals and 5 or 4 or3 or 2 or 1 pulsed signals. In one or more examples, the specific drivesignal configuration directed by energy inputs may be controlled and/orbased upon EEPROM settings in generator (14) and/or user power levelselection(s). By way of further example, surgical instrument (10) mayinclude a two-button configuration for selectively directing ultrasonicand RF energies as described herein. Various examples of instrumentshaving two-button input configurations are described in various patentreferences cited herein. In any case, it will be appreciated that theinvention described herein is not intended to be unnecessarily limitedto a particular input button, switch, etc. to the extent that any formof input may be so used.

Surgical instrument (12) further includes a first data circuit (42) anda second data circuit (44) in communication with generator (14). Forexample, first data circuit (42) indicates a burn-in frequency slope.Additionally or alternatively, any type of information may becommunicated to second data circuit (42) for storage therein via a datacircuit interface (e.g., using a logic device). Such information maycomprise, for example, an updated number of operations in which surgicalinstrument (12) has been used and/or dates and/or times of its usage. Inother examples, second data circuit (44) may transmit data acquired byone or more sensors (e.g., an instrument-based temperature sensor). Instill other examples, second data circuit (44) may receive data fromgenerator (14) and provide an indication to a clinician (e.g., an LEDindication or other visible indication) based on the received data toand/or from surgical instrument (12). In the present example, seconddata circuit (44) stores information about the electrical and/orultrasonic properties of an associated transducer (24) and/or endeffector (20), which includes data measured and collected fromultrasonic blade (28) and/or RF electrodes (30).

To this end, various processes and techniques described herein areperformed by a controller (46), which includes internal logic. In oneexample, controller (46) has at least one processor and/or othercontroller device in communication with generator (14), ultrasonic blade(28), RF electrodes (30), and other inputs and outputs described hereinfor monitoring and performing such processes and techniques. In oneexample, controller (46) has a processor configured to monitor userinput provided via one or more inputs and capacitive touch sensors.Controller (46) may also include a touch screen controller to controland manage the acquisition of touch data from a capacitive touch screen.

With reference to FIGS. 1-2B, handle assembly (18) further includes atrigger (48) operatively connected to clamp arm (26). Trigger (48) andclamp arm (26) are generally biased toward the unactuated, openconfiguration. However, selectively manipulating trigger (48) proximallypivots clamp arm (26) toward ultrasonic blade (28) from the openposition to the closed position. As used in the present example, clamparm (26) and ultrasonic blade (28) may also be generally referred torespectively as upper and lower jaws of surgical instrument (12). In theopen position, clamp arm (26) and ultrasonic blade (28) are configuredto receive the tissue, whereas clamp arm (26) is configured to clamptissue against ultrasonic blade (28) for grasping, sealing, and/orcutting the tissue.

Ultrasonic blade (28) ultrasonically vibrates to seal and/or cut thetissue, whereas RF electrodes (30) provide electrical power to thetissue. RF electrodes (30) of the present example are all electricallysimilar electrodes with ultrasonic blade (28) also electricallyconnected as a return electrode. As used therein, the term “electrode”may thus apply to both RF electrodes (30) and ultrasonic blade (28) withrespect to the RF electrical circuit. Without tissue, the electricalcircuit from RF electrodes (30) to ultrasonic blade (28) is open,whereas the electrical circuit is closed by the tissue between RFelectrode (30) and ultrasonic blade (28) in use. RF electrodes (30) maybe activated to apply RF energy alone or in combination with ultrasonicactivation of ultrasonic blade (28). For example, activating only RFelectrodes (30) to apply RF energy alone may be used for spotcoagulating without concern for inadvertently cutting tissue withultrasonically activated ultrasonic blade (28). However, the combinationof ultrasonic energy and RF energy may be used for sealing and/orcutting tissue to achieve any combination of diagnostic or therapeuticeffects, various examples of which will be described below in greaterdetail.

As noted above, generator (14) is a single output generator that candeliver power through a single port to provide both RF and ultrasonicenergy such that these signals can be delivered separately orsimultaneously to end effector (20) for cutting and/or sealing tissue.Such a single output port generator (14) has a single output transformerwith multiple taps to provide power, either for RF or for ultrasonicenergy, to end effector (20) depending on the particular treatment beingperformed on the tissue. For example, generator (14) may deliver energywith higher voltage and lower current to drive ultrasonic transducer(24), with lower voltage and higher current as required to drive RFelectrodes (30) for sealing tissue, or with a coagulation waveform forspot coagulation using either monopolar or bipolar electrosurgicalelectrodes. The output waveform from generator (14) can be steered,switched, or filtered to provide the desired frequency to end effector(20) of surgical instrument (12).

II. INTERROGATION OF TERMINATION PARAMETERS FOR SEALING VARIOUS SIZES OFTISSUE WITH INHIBITED TISSUE TRANSECTION

With respect to FIG. 3, sealing a variety of tissue sizes whileinhibiting tissue transection correlates in the present example torespective termination parameters that are measurable by surgical system(10) of FIG. 1. More particularly, controller (46) is configured toidentify whether or not one or more small, medium, or large terminationparameters have respectively occurred in small, medium, or large tissueto signal that the tissue has been sealed. Such seal identification maybe used in any operation of surgical system (10).

Generally, a method (1310) of interrogating termination parameters fortissues of various size includes an initial step (1312) of activatingultrasonic and RF energies. Once ultrasonic and RF energies areactivated, controller (46) identifies the size of the tissue betweenultrasonic blade (28) and clamp arm (26) in a step (1314) as small,medium, or large tissue. Any of the methods for identifying tissue sizedescribed herein and/or incorporated by reference may be used in step(1314), or, alternatively, the clinician may identify the tissue sizebased on a visual inspection of the vessel.

In any case, based on the tissue size identified in step (1314),controller (46) sets at least two predetermined termination parametersfrom a respective pair of collections of termination parameters storedin memory of controller (46) in a step (1316). Such terminationparameters include, but are not necessarily limited to, RF impedance,ultrasonic energy cap, total energy cap, ultrasonic frequency change, ortime. Controller (46) then interrogates the tissue with measurements ofthese termination parameters in a step (1320) while generating a desiredburst pressure in the tissue by application of the activated ultrasonicand RF energies in a step (1320). Ultrasonic and RF energies continue tobe applied to the tissue until the at least two predeterminedtermination parameters are achieved in the tissue in a step (1322),which indicates that the tissue is sealed in a step (1324). In response,controller terminates the RF and ultrasonic energies to inhibittransecting the tissue.

By way of example, and in reference to FIG. 4, a more particular version(1410) of method (1310) (see FIG. 3) has step (1312) of activatingultrasonic and RF energies to initiate sealing of the tissue andidentifying the size of the tissue as small, medium, or large in step(1314). In addition, predetermined termination parameters (1416) foreach of small, medium, and large tissues are respectively stored andaccessed by controller (46) in a step (1418), which correlates theidentified size of the tissue to the stored predetermined terminationparameters (1416). Based on the correlated predetermined terminationparameters of step (1418), controller (46) sets a predetermined firsttermination parameter in a step (1420) and simultaneously sets apredetermined second termination parameter in a step (1422). Followingsetting of the predetermined first and second termination parameters instep (1420) and step (1422), controller (46) measures a firsttermination parameter and a second termination parameter associated withthe real-time tissue treatment in respective step (1424) and step(1426).

Generally, RF and ultrasonic energies remain activated until the one orboth of the measured first and second termination parameters achievesthe predetermined first and second termination parameters. To this end,a step (1428) compares the measured first termination parameter to thepredetermined first termination parameter and determines whether themeasured first termination parameter reached the predetermined firsttermination parameter. In the event that the measured first terminationparameter has not reached the predetermined first termination parameterin step (1428), step (1424) and step (1428) loop for repeatedcomparisons. Once the measured first termination parameter reaches thepredetermined first termination parameter in step (1428), notice isprovided to a logic step (1430), which is discussed below in moredetail.

While step (1424) and (1428) loop for repeated comparisons with respectto first termination parameter, a step (1432) compares the measuredsecond termination parameter to the predetermined second terminationparameter and determines whether the measured second terminationparameter reached the predetermined second termination parameter. In theevent that the measured second termination parameter has not reached thepredetermined second termination parameter in step (1432), step (1426)and step (1432) loop for repeated comparisons. Once the measured secondtermination parameter reaches the predetermined second terminationparameter in step (1432), notice is provided to logic step (1430).

Logic step (1430) receives notice of at least one of the first or secondtermination parameters being reached to thereby determine that thetissue is sealed while inhibiting transection of the tissue. In oneexample, logic step (1430) receives notice of either the firsttermination parameter being reached or the second termination parameterbeing reached to determine that the tissue is sealed. In anotherexample, logic step (1430) receives notice of one of the first or secondtermination parameters being reached and waits until the remainingtermination parameter is reached to thus determine that the tissue issealed. In any case, the tissue is sealed in a step (1432) andterminates the RF and ultrasonic energies in a following step (1434)while inhibiting transection of the tissue. While the above version(1410) of method (1310) (see FIG. 3) sets and measures two terminationparameters, alternative versions and methods may use only one suchtermination parameter or more than two such termination parameters. Theinvention described herein is thus not intended to be unnecessarilylimited to two termination paraments for identifying the sealing oftissue while inhibiting transection thereof.

III. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

A method of sealing a tissue with a surgical instrument including acontroller and an ultrasonic blade and an RF electrode respectivelyconfigured to deliver an ultrasonic energy and an RF energy to thetissue, wherein the controller includes a memory having a firstcollection of predetermined termination parameters stored thereon,wherein the first collection of predetermined termination parametersincludes a first smaller tissue predetermined termination parameter anda first larger tissue predetermined termination parameter, the methodcomprising: (a) activating one or both of the ultrasonic blade or the RFelectrode to apply ultrasonic energy or RF energy, respectively, totissue; (b) setting one of the first smaller tissue predeterminedtermination parameter or the first larger tissue predeterminedtermination parameter; (c) measuring a first measured terminationparameter with the controller; and (d) terminating one or both of theultrasonic energy or the RF energy via the controller when the firstmeasured termination parameter reaches the set one of the first smallertissue predetermined termination parameter or the first larger tissuepredetermined termination parameter to thereby inhibit transecting thetissue.

Example 2

The method of Example 1, wherein the memory has a second collection ofpredetermined termination parameters including a second smaller tissuepredetermined termination parameter and a second larger tissuepredetermined termination parameter stored thereon, and wherein themethod further comprises: (a) setting one of the second smallerpredetermined termination parameter and the second larger tissuepredetermined termination parameter; (b) measuring a second measuredtermination parameter with the controller; and (c) terminating one orboth of the ultrasonic energy or the RF energy via the controller whenthe second measured termination parameter respectively reaches the setone of the second smaller tissue predetermined termination parameter orthe second larger tissue predetermined termination parameter to therebyinhibit transecting the tissue.

Example 3

The method of Example 2, wherein terminating one or both of theultrasonic energy or the RF energy further includes terminating one orboth of the ultrasonic energy or the RF energy via the controller when:(i) the set one of the first smaller tissue predetermined terminationparameter or the first larger tissue predetermined termination parameterreaches the first measured predetermined termination parameter; and (ii)the set one of the second smaller tissue predetermined terminationparameter or the second larger tissue predetermined terminationparameter reaches the second measured predetermined terminationparameter to thereby inhibit transecting the tissue.

Example 4

The method of any one or more of Examples 2 through 3, wherein the firstcollection and the second collection of predetermined terminationparameters are selected from the group consisting of RF impedance,ultrasonic energy cap, total energy cap, ultrasonic frequency change,and time.

Example 5

The method of any one or more of Examples 2 through 4, furthercomprising simultaneously setting the first and second predeterminedtermination parameters.

Example 6

The method of Example 1, further comprising identifying a relative sizeof the tissue as a smaller tissue size or a larger tissue size.

Example 7

The method of Example 6, further comprising: (a) correlating the smallertissue size to a first smaller tissue predetermined termination; and (b)setting the first smaller tissue predetermined termination parameter ofthe first collection of predetermined termination parameters.

Example 8

The method of Example 7, wherein the memory has a second collection ofpredetermined termination parameters including a second smaller tissuepredetermined termination parameter and a second larger tissuepredetermined termination parameter stored thereon, and wherein themethod further comprises: (a) correlating the smaller tissue size to asecond smaller tissue predetermined termination parameter; and (b)setting the second smaller tissue predetermined termination parameter ofthe second collection of predetermined termination parameters.

Example 9

The method of Example 8, further comprising measuring a second measuredtermination parameter with the controller.

Example 10

The method of Example 6, further comprising: (a) correlating the largertissue size to a first larger tissue predetermined terminationparameter; and (b) setting the first larger tissue predeterminedtermination parameter of the first collection of predetermined tissueparameters.

Example 11

The method of Example 10, wherein the memory has a second collection ofpredetermined termination parameters including a second smaller tissuepredetermined termination parameter and a second larger tissuepredetermined termination parameter stored thereon, and wherein themethod further comprises: (a) correlating the larger tissue size to asecond larger tissue predetermined termination parameter; and (b)setting the second larger tissue predetermined termination parameter ofthe second collection of predetermined termination parameters.

Example 12

The method of Example 11, further comprising measuring a second measuredtermination parameter with the controller.

Example 13

The method of any one or more of Examples 1 through 12, furthercomprising generating a desired burst pressure in the tissue.

Example 14

The method of any one or more of Examples 1 through 13, furthercomprising sealing the tissue.

Example 15

The method of Example 1, wherein the first collection of thepredetermined termination parameters are selected from the groupconsisting of RF impedance, ultrasonic energy cap, total energy cap,ultrasonic frequency change, and time.

Example 16

A method of sealing a tissue with a surgical instrument including acontroller and an ultrasonic blade and an RF electrode respectivelyconfigured to deliver an ultrasonic energy and an RF energy to thetissue, wherein the controller includes a memory having a firstcollection of predetermined termination parameters and a secondcollection of predetermined termination parameters stored thereon,wherein the first collection of predetermined termination parametersincludes a first smaller tissue predetermined termination parameter anda first larger tissue predetermined termination parameter, wherein thesecond collection of predetermined termination parameters includes asecond smaller tissue predetermined termination parameter and a secondlarger tissue predetermined termination, the method comprising: (a)activating one or both of the ultrasonic blade or the RF electrode toapply ultrasonic energy or RF energy, respectively, to tissue; (b)identifying a relative size of the tissue as a smaller tissue size or alarger tissue size; (c) setting one of the first smaller tissuepredetermined termination parameter or the first larger tissuepredetermined termination parameter based on the identified relativesize of the tissue; (d) setting one of the second smaller predeterminedtermination parameter and the second larger tissue predeterminedtermination parameter based on the identified relative size of thetissue; (e) measuring a first measured termination parameter with thecontroller; (f) measuring a second measured termination parameter withthe controller; and (g) terminating one or both of the ultrasonic energyor the RF energy via the controller when at least one of the firstmeasured termination parameter or the second measured terminationparameter respectively reaches the set one of the first or secondsmaller tissue predetermined termination parameters or the set one ofthe first or second larger tissue predetermined termination parametersto thereby inhibit transecting the tissue.

Example 17

The method of Example 16, wherein the identifying the relative size ofthe tissue further includes identifying the relative size of the tissueas the smaller tissue size or the larger tissue size with thecontroller.

Example 18

The method of any one or more of Examples 16 through 17, furthercomprising simultaneously setting the first and second predeterminedtermination parameters.

Example 19

The method of any one or more of Examples 16 through 18, wherein thefirst collection and the second collection of predetermined terminationparameters are selected from the group consisting of RF impedance,ultrasonic energy cap, total energy cap, ultrasonic frequency change,and time.

Example 20

An ultrasonic surgical instrument, comprising: (a) an end effectorconfigured to actuate from a first configuration to a secondconfiguration, including: (i) an ultrasonic blade configured toselectively apply ultrasonic energy to tissue, and (ii) an RF electrodeconfigured to selectively apply RF energy to tissue; (b) a shaftassembly projecting proximally from the end effector; (c) a bodyprojecting proximally from the shaft assembly, wherein the body includesan energy input operatively connected to the ultrasonic blade; and (d) acontroller operatively connected to the ultrasonic blade and the RFelectrode, wherein the controller is configured to measure a firstmeasured termination parameter of the tissue via at least one of theultrasonic blade and the RF electrode, wherein the controller has amemory including a first collection of predetermined terminationparameters with a first smaller tissue predetermined terminationparameter and a first larger tissue predetermined termination parameterstored thereon, and wherein the controller is further configured toterminate one or both of the ultrasonic energy or the RF energy when thefirst measured termination parameter reaches the set one of the firstsmaller tissue predetermined termination parameter or the first largertissue predetermined termination parameter to thereby inhibittransecting the tissue.

IV. MISCELLANEOUS

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of any claims.

Any one or more of the teaching, expressions, embodiments, examples,etc. described herein may be combined with any one or more of theteachings, expressions, embodiments, examples, etc. described in U.S.patent application Ser. No. 15/967,758, entitled “Combination Ultrasonicand Electrosurgical Instrument with Clamp Arm Position Input and Methodfor Identifying Tissue State,” filed on May 1, 2018, published as U.S.Pub. No. 2018/0333182 on Nov. 22, 2018; U.S. patent application Ser. No.15/967,763, entitled “Combination Ultrasonic and ElectrosurgicalInstrument with Adjustable Energy Modalities and Method for SealingTissue and Inhibiting Tissue Resection,” filed on May 1, 2018, publishedas U.S. Pub. No. 2018/0333187 on Nov. 22, 2018; U.S. patent applicationSer. No. 15/967,770, entitled “Combination Ultrasonic andElectrosurgical Instrument with Adjustable Clamp Force and RelatedMethods,” filed on even date herewith; U.S. patent application Ser. No.15/967,775, entitled “Combination Ultrasonic and ElectrosurgicalInstrument with Adjustable Energy Modalities and Method for LimitingBlade Temperature,” filed on May 1, 2018, published as U.S. Pub. No.2018/0333188 on Nov. 22, 2018; and/or U.S. patent application Ser. No.15/967,784, entitled “Combination Ultrasonic and ElectrosurgicalInstrument and Method for Sealing Tissue in Successive Phases,” filed onMay 1, 2018, published as U.S. Pub. No. 2018/0333190 on Nov. 22, 2018.The disclosure of each of these applications is incorporated byreference herein.

Further, any one or more of the teachings, expressions, embodiments,examples, etc. described herein may be combined with any one or more ofthe teachings, expressions, embodiments, examples, etc. described inU.S. patent application Ser. No. 15/967,740, entitled “CombinationUltrasonic and Electrosurgical Instrument Having Electrical CircuitsWith Shared Return Path,” filed on May 1, 2018, published as U.S. Pub.No. 2018/0333177 on Nov. 22, 2018; U.S. patent application Ser. No.15/967,746, entitled “Combination Ultrasonic and ElectrosurgicalInstrument Having Slip Ring Electrical Contact Assembly,” filed on May1, 2018, issued as U.S. Pat. No. 10,945,778 on Mar. 16, 2021; U.S.patent application Ser. No. 15/967,747, entitled “Combination Ultrasonicand Electrosurgical Instrument Having Electrically Insulating Features,”filed on May 1, 2018, issued as U.S. Pat. No. 10,945,779 on Mar. 16,2021; U.S. patent application Ser. No. 15/967,751, entitled “CombinationUltrasonic and Electrosurgical Instrument Having Curved UltrasonicBlade,” filed on May 1, 2018, issued as U.S. Pat. No. 11,033,316 on Jun.15, 2021; U.S. patent application Ser. No. 15/967,753, entitled“Combination Ultrasonic and Electrosurgical Instrument Having Clamp ArmElectrode,” filed on May 1, 2018, issued as U.S. Pat. No. 11,058,472 onJul. 13, 2021; U.S. patent application Ser. No. 15/967,759, entitled“Combination Ultrasonic and Electrosurgical Instrument Having UltrasonicWaveguide With Distal Overmold Member,” filed on May 1, 2018, issued asU.S. Pat. No. 11,051,866 on Jul. 6, 2021; U.S. patent application Ser.No. 15/967,761, entitled “Combination Ultrasonic and ElectrosurgicalSystem Having Generator Filter Circuitry,” filed on May 1, 2018,published as U.S. Pub. No. 2018/0333184 on Nov. 22, 2018; and/or U.S.patent application Ser. No. 15/967,764, entitled “Combination Ultrasonicand Electrosurgical System Having EEPROM and ASIC Components,” filed onMay 1, 2018, issued as U.S. Pat. No. 11,129,661 on Sep. 28, 2021. Thedisclosure of each of these applications is incorporated by referenceherein.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,844,789, entitled“Automated End Effector Component Reloading System for Use with aRobotic System,” issued Sep. 30, 2014, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,820,605, entitled“Robotically-Controlled Surgical Instruments,” issued Sep. 2, 2014, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,616,431, entitled “Shiftable Drive Interface forRobotically-Controlled Surgical Tool,” issued Dec. 31, 2013, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,573,461, entitled “Surgical Stapling Instruments with Cam-DrivenStaple Deployment Arrangements,” issued Nov. 5, 2013, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 8,602,288,entitled “Robotically-Controlled Motorized Surgical End Effector Systemwith Rotary Actuated Closure Systems Having Variable Actuation Speeds,”issued Dec. 10, 2013, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 9,301,759, entitled“Robotically-Controlled Surgical Instrument with SelectivelyArticulatable End Effector,” issued Apr. 5, 2016, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 8,783,541,entitled “Robotically-Controlled Surgical End Effector System,” issuedJul. 22, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pat. No. 8,479,969, entitled “Drive Interface for OperablyCoupling a Manipulatable Surgical Tool to a Robot,” issued Jul. 9, 2013;U.S. Pat. No. 8,800,838, entitled “Robotically-Controlled Cable-BasedSurgical End Effectors,” issued Aug. 12, 2014, the disclosure of whichis incorporated by reference herein; and/or U.S. Pat. No. 8,573,465,entitled “Robotically-Controlled Surgical End Effector System withRotary Actuated Closure Systems,” issued Nov. 5, 2013, the disclosure ofwhich is incorporated by reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a clinician immediately prior to a procedure. Those skilled in theart will appreciate that reconditioning of a device may utilize avariety of techniques for disassembly, cleaning/replacement, andreassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention is understood not to belimited to the details of structure and operation shown and described inthe specification and drawings.

We claim:
 1. A method of sealing a tissue with a surgical instrumentincluding a controller and an ultrasonic blade and an RF electroderespectively configured to deliver an ultrasonic energy and an RF energyto the tissue, wherein the controller includes a memory having a firstcollection of predetermined termination parameters stored thereon,wherein the first collection of predetermined termination parametersincludes a first smaller tissue predetermined termination parameter anda first larger tissue predetermined termination parameter, the methodcomprising: (a) activating one or both of the ultrasonic blade or the RFelectrode to apply ultrasonic energy or RF energy, respectively, totissue; (b) identifying a relative size of the tissue as a smallertissue size or a larger tissue size; (c) based upon the relative size ofthe tissue, setting one of the first smaller tissue predeterminedtermination parameter or the first larger tissue predeterminedtermination parameter; (d) measuring a first measured terminationparameter with the controller; and (e) terminating one or both of theultrasonic energy or the RF energy via the controller when the firstmeasured termination parameter reaches the set one of the first smallertissue predetermined termination parameter or the first larger tissuepredetermined termination parameter to thereby inhibit transecting thetissue.
 2. The method of claim 1, wherein the memory has a secondcollection of predetermined termination parameters including a secondsmaller tissue predetermined termination parameter and a second largertissue predetermined termination parameter stored thereon, and whereinthe method further comprises: (a) setting one of the second smallerpredetermined termination parameter and the second larger tissuepredetermined termination parameter; (b) measuring a second measuredtermination parameter with the controller; and (c) terminating one orboth of the ultrasonic energy or the RF energy via the controller whenthe second measured termination parameter respectively reaches the setone of the second smaller tissue predetermined termination parameter orthe second larger tissue predetermined termination parameter to therebyinhibit transecting the tissue.
 3. The method of claim 2, whereinterminating one or both of the ultrasonic energy or the RF energyfurther includes terminating one or both of the ultrasonic energy or theRF energy via the controller when: (i) the set one of the first smallertissue predetermined termination parameter or the first larger tissuepredetermined termination parameter reaches the first measuredpredetermined termination parameter; and (ii) the set one of the secondsmaller tissue predetermined termination parameter or the second largertissue predetermined termination parameter reaches the second measuredpredetermined termination parameter to thereby inhibit transecting thetissue.
 4. The method of claim 3, wherein the first collection and thesecond collection of predetermined termination parameters are selectedfrom the group consisting of RF impedance, ultrasonic energy cap, totalenergy cap, ultrasonic frequency change, and time.
 5. The method ofclaim 3, further comprising simultaneously setting the first and secondpredetermined termination parameters.
 6. The method of claim 1, furthercomprising: (a) correlating the smaller tissue size to the first smallertissue predetermined termination parameter; and (b) setting the firstsmaller tissue predetermined termination parameter of the firstcollection of predetermined termination parameters.
 7. The method ofclaim 6, wherein the memory has a second collection of predeterminedtermination parameters including a second smaller tissue predeterminedtermination parameter and a second larger tissue predeterminedtermination parameter stored thereon, and wherein the method furthercomprises: (a) correlating the smaller tissue size to the second smallertissue predetermined termination parameter; and (b) setting the secondsmaller tissue predetermined termination parameter of the secondcollection of predetermined termination parameters.
 8. The method ofclaim 7, further comprising measuring a second measured terminationparameter with the controller.
 9. The method of claim 1, furthercomprising: (a) correlating the larger tissue size to the first largertissue predetermined termination parameter; and (b) setting the firstlarger tissue predetermined termination parameter of the firstcollection of predetermined tissue parameters.
 10. The method of claim9, wherein the memory has a second collection of predeterminedtermination parameters including a second smaller tissue predeterminedtermination parameter and a second larger tissue predeterminedtermination parameter stored thereon, and wherein the method furthercomprises: (a) correlating the larger tissue size to the second largertissue predetermined termination parameter; and (b) setting the secondlarger tissue predetermined termination parameter of the secondcollection of predetermined termination parameters.
 11. The method ofclaim 10, further comprising measuring a second measured terminationparameter with the controller.
 12. The method of claim 1, furthercomprising generating a desired burst pressure in the tissue.
 13. Themethod of claim 1, further comprising sealing the tissue.
 14. The methodof claim 1, wherein the first collection of the predeterminedtermination parameters are selected from the group consisting of RFimpedance, ultrasonic energy cap, total energy cap, ultrasonic frequencychange, and time.
 15. A method of sealing a tissue with a surgicalinstrument including a controller and an ultrasonic blade and an RFelectrode respectively configured to deliver an ultrasonic energy and anRF energy to the tissue, wherein the controller includes a memory havinga first collection of predetermined termination parameters and a secondcollection of predetermined termination parameters stored thereon,wherein the first collection of predetermined termination parametersincludes a first smaller tissue predetermined termination parameter anda first larger tissue predetermined termination parameter, wherein thesecond collection of predetermined termination parameters includes asecond smaller tissue predetermined termination parameter and a secondlarger tissue predetermined termination, the method comprising: (a)activating one or both of the ultrasonic blade or the RF electrode toapply ultrasonic energy or RF energy, respectively, to tissue; (b)identifying a relative size of the tissue as a smaller tissue size or alarger tissue size; (c) setting one of the first smaller tissuepredetermined termination parameter or the first larger tissuepredetermined termination parameter based on the identified relativesize of the tissue; (d) setting one of the second smaller predeterminedtermination parameter and the second larger tissue predeterminedtermination parameter based on the identified relative size of thetissue; (e) measuring a first measured termination parameter with thecontroller; (f) measuring a second measured termination parameter withthe controller; and (g) terminating one or both of the ultrasonic energyor the RF energy via the controller when at least one of the firstmeasured termination parameter or the second measured terminationparameter respectively reaches the set one of the first or secondsmaller tissue predetermined termination parameters or the set one ofthe first or second larger tissue predetermined termination parametersto thereby inhibit transecting the tissue.
 16. The method of claim 15,wherein the identifying the relative size of the tissue further includesidentifying the relative size of the tissue as the smaller tissue sizeor the larger tissue size with the controller.
 17. The method of claim15, further comprising simultaneously setting the first and secondpredetermined termination parameters.
 18. The method of claim 15,wherein the first collection and the second collection of predeterminedtermination parameters are selected from the group consisting of RFimpedance, ultrasonic energy cap, total energy cap, ultrasonic frequencychange, and time.
 19. The method of claim 15, further comprisinggenerating a desired burst pressure in the tissue.
 20. A method ofsealing a tissue with a surgical instrument including a controller andan end effector respectively configured to deliver energy to the tissue,wherein the controller includes a memory having a first collection ofpredetermined termination parameters and a second collection ofpredetermined termination parameters stored thereon, wherein the firstcollection of predetermined termination parameters includes a firstsmaller tissue predetermined termination parameter and a first largertissue predetermined termination parameter, wherein the secondcollection of predetermined termination parameters includes a secondsmaller tissue predetermined termination parameter and a second largertissue predetermined termination, the method comprising: (a) activatingthe end effector to apply the energy to tissue; (b) identifying arelative size of the tissue as a smaller tissue size or a larger tissuesize; (c) when the relative size of the tissue is identified as thesmaller tissue size, setting at least one of the first smaller tissuepredetermined termination parameter and the second smaller tissuepredetermined termination parameter and measuring a first measuredtermination parameter with the controller; (d) when the relative size ofthe tissue is identified as the larger tissue size, setting at least oneof the first larger tissue predetermined termination parameter and thesecond larger tissue predetermined termination parameter and measuring asecond measured termination parameter with the controller; (e)terminating the energy via the controller when the first measuredtermination parameter reaches the at least one of the first smallertissue predetermined termination parameter and the second smaller tissuepredetermined termination parameter or when the second measuredtermination parameter reaches the at least one of the first largertissue predetermined termination parameter and the second larger tissuepredetermined termination parameter.